人工关节集采对下肢全关节置换的影响研究

Study on the impact of artificial joint centralized-procurement on lower extremity total joint arthroplasty

目的探讨人工关节带量采购(简称集采)对下肢全关节置换(TJA)的影响。方法选取2021年5月至2023年3月宁波大学附属李惠利医院收治的行下肢TJA的185例患者为研究对象。根据集采政策实施前后分为集采前(2021年5月至2022年5月)90例、集采后(2022年6月至2023年3月)95例;再根据手术方式分为全髋关节置换(THA)组95例、全膝关节表面置换(TKA)组90例。比较集采前后THA组和TKA组患者术后并发症发生情况、住院总费用、手术一次性材料费用、手术时间、术中出血量、住院时间、术前和术后5 d视觉模拟评分法(VAS)、住院满意度。结果所有患者随访期间均未见关节僵硬、脱位,假体周围感染,假体周围骨折等并发症。集采后THA组和TKA组患者住院总费用及手术一次性材料费用均低于集采前,住院满意度均高于集采前,差异均有统计学意义(均P<0.05)。与术前比较,集采前后THA组和TKA组患者术后5 d VAS评分均降低,差异均有统计学意义(均P<0.05)。集采前后THA组和TKA组患者住院时间、手术时间、术中出血量比较,差异均无统计学意义(均P>0.05)。结论集采政策实施后,下肢TJA患者的住院费用降低,住院满意度提高,术中及术后状况无明显影响。

Objective To investigate the impact of the artificial joint centralized-procurement on lower extremity total joint arthroplasty(TJA).Methods One hundred and eighty-five patients admitted to the Affiliated Lihuili Hospital of Ningbo University,who underwent lower limb TJA from May 2021 to March 2023 were selected for the study.Among whom,90 cases who underwent the surgery before the implementation of the centralized-procurement policy(May 2021 to May 2022)were classified as pre-procurement group,while another 95 cases who received the surgery after the centralized-procurement(June 2022 to March 2023)were considered as post-procurement group;they were further divided into total hip arthroplasty(THA)group and total knee arthroplasty(TKA)group according to the surgical methods.Postoperative complications,total hospitalization cost,cost of surgical disposable materials,operation time,intraoperative bleeding,length of hospital stay,visual analogue scale(VAS)scores before and the 5th day after operation,and hospitalization satisfaction were compared between the pre-and post-procurement groups.Results No complications such as joint stiffness,dislocation,periprosthetic infection,and periprosthetic fracture were seen during the follow-up period in THA and TKA groups.The total hospitalization cost and the cost of surgical disposable materials in THA and TKA subgroups of post-procurement group were both significantly lower,and the hospitalization satisfaction was statistically higher when compared with the two subgroups of pre-procurement group(all P<0.05).Compared with the preoperative results,the VAS scores 5 days after surgery in pre-and post-procurement groups were decreased,and the differences were statistically significant(all P<0.05).There was no significant difference in hospitalization time,operation time and intraoperative bleeding between the pre-and post-procurement groups(all P>0.05).Conclusion After the implementation of the centralized-procurement policy,hospital cost for patients with lower extremity TJA decreases,patients report improved hospital satisfaction,and no significant impacts occur on operative and post-operative conditions.